Provider First Line Business Practice Location Address:
8636 US HIGHWAY 27 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTLER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41006-9232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-472-3395
Provider Business Practice Location Address Fax Number:
859-740-1095
Provider Enumeration Date:
11/25/2025